[Taipans]

I have been seeking treatment for years for depression and social anxiety. The social anxiety being the worse of the two. I have been on every medication outside of the ones Lithium is in, and nothing has helped. I have anxiety all day, usually for no reason at all, just a constant un easyness. Then when I go out in public to do anything, pump gas, grocery store, interact with friends and family. I almost get to a panic state with the rise in anxiety. This has left me falling more and more into a hermit phase, although work and having a family has kept me from becoming a complete recluse. Anyhow, I also experience mood swings, Im rarely happy, even if I should be. I'm always negative and in a foul mood, for no reason what-so-ever. I stress out over every detail of my day and life. And im always going from ok to being snappy with my kids and wife. To the point it puts everyone on edge and is causing problems at home. I go to the doctor yesterday after again a decade of treatment, of course with various doctors. (this is my second visit with this new one) and he sits down with one of the other doctors to go over my file and history. They both tell me they have a suspicion that I might be Bipolar. This because of my unstable mood and anxiety / depression problems. Also because of my lack of any luck with all the other types of medications. I was pretty shocked, as I always thought bipolar people went from one extreme to the other, having manic episodes. Which I dont ever have a high manic feeling. Only times of depression and being down. Could they be right? Does it make any sense?

They prescribed to me Lithium, 300mg in the morning, 300mg in the evening. They told me I shouldnt feel any better until the end of the month when I will be doubling my nightly dosage to 600mg. At this point after 2 weeks I will have to get my blood taken to check my levels. Although im not sure what they will be checking for, I suppose to right level of lithium in my blood, or if its screwing something else up? I didnt think to get to much into detail on my questions.

Anyhow what does everyone else think? Can bipolar disorder follow the lines of my symptoms and actually not be very severe? Is lithium something I should be taking and how many others are on it? Does it help, how dangerous is it really?

Thank you for any input you guys give,

Mark

[darkeyes]

Bipolar disorder, comes in different variations, it is almost a stereotypical thought for someone to think Bipolar means all go from depression to manic episodes, some can have mild, hypomanic episodes if any at all, and then have deep depressive ones and vice versa.
The DSM-IV describes the criteria for which DX fits, and that is not always 100% but pretty close. Psychologists and Psychiatrists have used this manual for years as a guide, helping them with Dxing.
Doesn't mean "all" do, nothing is written in stone, but is one of a pretty universal guide manual.
Sorry for straying, getting back to one of the many answers to possible question, is yes,a person can be Bipolar and not have extreme mood swings.
I had been DXed with clinical depression, given AD's but over time they fizzed out, other life events seemed to trigger things, then later I was DXed as Bipolar-II (mild) and ADD (mild) which I suspected my whole life.
After being on a mood stabilizer and recently Concerta, I'm doing well.
Unfortunately, things can take time to get it just right, but when it happens, and it will, it's great to feel back to "normal",getting through life on a better track.
Lithium is an excellent med., Lithobid is really good, sort of like a time release function, little more costly than the other formulations of Lithium, but worth it.
It has the longest track record, and is not dangerous as some people have been mislead to believe. My oldest brother has been on Lithiium for 30+ yrs. Lithium was the best med he ever was prescribed, like a success story.
He was DXed with Bipolar-I and had some pretty violent manic episodes in the past, including depressive ones.
I had been on Depakote,didn't do well with it,switched to Lithobid, which was great but being that I suffer from deep depression and not mania, my pdoc suggested I give Lamictal a try, and it's been great. When I was on the Lithobid, my depressive side wasn't addressed as well as with Lamictal. At first with an AD added while on the Lithobid, things seemed balanced, but even the same AD alone didn't work anymore, for me AD's pooped out. Another thing that most likely proved I was suffering with Bipolar and not clinical depression. Too bad, in the begining I hadn't gone to a pdoc, cause the GP kept saying I was depressed and would just write scripts for one kind of med after another.
Most mood stabilizers should always be titrated gradually, it reduces the chances of nasty side effects and helps the doc come to the most effective therapeutic dose, using the lowest dose, rather than go gung ho and find the patient may not need a high or higher dose.
I wish you lots of luck with this, I know it's extremely frustrating, but don't give up.
Welcome to PC you will find a lot of supportive people here, and info. too.
Take care,
DE

[DaveyJones]

Hi, Mark...

I am another who has been through much of what you and Roseanne describe...I was treated for depression for years with no real luck...lots of irritability and anger, too. I did have hypomanic episodes (mild mania) but didn't really realize it until they finally got my diagnosis right after 8 years.

My depression is gone or nearly so on lithium and Lamictal, no antidepressants. Antidepressants actually made me more depressed, but I guess I'm just special!

Anyway, when you are on lithium, you have to monitor the blood levels closely...there is a fairly narrow range that the lithium level must fall in to be effective but not toxic...that level should be between .6 - 1.2 meq/l (milli-equivalents per liter--don't ask me what that means). The dosage you'll be taking shouldn't be a problem...I'm a guy about 6'2" and 220 lbs. I take 1800 mg/day, and my blood level runs around .9 meq/l. (Your mileage may vary ). Be sure and drink plenty of water--nothing outrageous, if you drink as much water as you're supposed to, 6-8 glasses a day, you'll be fine.

Allowing a month for the lithium to start working is reasonable. You may find that you will need another drug to help with the depression, but the lithium may help. The idea is to get your mood stable first and then work on the depression. You have to do that because giving antidepressants to a bipolar, even a depressed one can send them into a manic episode without a mood stabilizer.

Oh, I forgot to mention, the blood test will also check for thyroid function...lithium therapy can suppress thyroid function in some people. If this is the case, your doc will probably prescribe a thyroid supplement like Synthroid or a generic equivalent. This really isn't a big deal, I know people who do just fine like this.

So now that I have rattled on for so long...Yes, the symptoms you describe can definitely be bipolar. They've treated you for the other things it could be, that didn't work. Everyone does associate bipolar with the radical manias and such, but it presents with a huge variety of symptoms, most of which can be caused by something else. If you show up with a manic episode, it's an easy call...if you don't have one, it is a LOT trickier to diagnose.

Lithium is generally regarded as the first-line treatment for bipolar disorder, so it is definitely appropriate for you to be on it...it has been a godsend for me. I don't think it is dangerous if used properly under a doctor's care. The side effects can be unpleasant for some, but I really haven't had much trouble myself.

I hope things work out for you...coping with bipolar is difficult...I think your doc is doing exactly the right thing. It'll be OK. If you have any problems or questions, feel free to shoot me a PM if you want. I'm glad to help.

DJ

[Taipans]

Thank you for the replies guys! It did make me feel better about everything. And a little better about Lithium.

Did you guys go through a month phase of a low dosage to see how your bodies handled it?

Anyhow I guess I will know if it does much of anything in about a month. I'm very interested in seeing if it clears up a lot of my disorders.

Thanks again,

Mark

[DaveyJones]

Hey, Mark...

I was in the hospital when I started taking lithium, so the dosage was ramped up over the course of 3 or 4 days, not weeks...I had no problems. Since you aren't in crisis, your doctor is being conservative, which is good, IMHO.

Again, the lithium by itself may not alleviate your depression...best practice is to only give antidepressants along with a mood stabilizer in bipolar disorder to prevent mania or hypomania. Or he could choose to add something like Lamictal, which DE mentioned and I also take. It is also very effective, particularly with bipolar depression.

Also remember, with any medication the side effects listed happen in a very small percentage of patients...odds are everything will be OK. If you do have a problem, there are plenty of alternatives.

Hope things go well,

DJ

[Taipans]

Well I have been on about 17 different medications for depression over the past 5 years. Currently im taking 2mg (1mg x 2) daily, of Clonazepam. Been on that a few months to help with my anxiety spikes. None of the other anti-depressents, even at high levels, such as Effexxor, Paxil, and so on every helped curb the depressive or hostile mood swings. Im crossing my fingers Lithium helps, and I will take warning that they might throw another med in to help with everything once a good dosage is reached. Once again thanks for the helpful and calming advice and information. It makes me feel much better about my situation!

Mark

[DaveyJones]

Yeah, I was on a bunch of AD's too, didn't do any good. Now I just take lithium and Lamictal, I'm MUCH better!

I'm happy to help...good luck.

DJ

[biplol]

I hope you can find an answer and get the treatment you need to feel better!

[Taipans]

Looking throught the Ask Patient site on what others rated Lithium I came across a ton of positives. But some disturbing side effects, and this was from the positive people. As for this quote:

"900 mg: slight weight gain (5-8lbs), hand tremor, significant hair loss (~1/3), tooth pain, very rapid tooth decay (lost 2 teeth with *very* good oral hygiene), decreased cognitive abilities. "

Umm... I know about the slight weight gain, which of course by diet and excercise can be controlled. But whats with the signaificant hair loss and very rapid tooth decay (lost 2 teeth!) my god. Has anyone ran into anything like this???

Now im starting to question it again. =(

Thanks guys.

Ah something else I wanted to ask,

Since this medication has a very fine line at the therapeutic level and being toxic, what happens if it edges over the toxic level? Do you instantly die or get sick or what. lol

And can you drink alcohol when on it (I enjoy beer very much) and can you take normal painkillers like Tylenol and Advil? I read someone on the warning label about ibuprofen or something.

I was misdiagnosed for over 30 yrs. so, yes, you can be treated for "plain" or unipolar depression & really be bipolar. I spent most of my time in deep depressions & was treated with every kind of anti-depressant (or so it seemed) & they would make me feel GREAT (hypo manic but didn't realize what it was at the time--just thought the AD's were working). The doc had to keep giving me higher doses cuz they would poop out after 6 weeks or so, then he would change me to a different one when the dose reached the highest possible. I was going to a GP. I'd HIGHLY recommend going to a psychiatrist. That's how I was finally diagnosed & my mother was bp, too. The GP should have taken that into consideration & sent me to a specialist, because bp runs in families very strongly.

I was put on Lithium which worked great for my mood, but I had the bad side effect of impaired kidney funtion (one of the things they check for in the blood test). I also had hair loss, weight gain, sleepiness and some memory problems & "foggy" thinking. Had to get off it due to the kidney thing, but it was great for my mood. I know many people who have been on it for years & had no negative side effects.

Ask you doc about alcohol use. I don't remember him saying anything about it. It might say something on the insert that comes with your prescription. If Lithium turns out to not be right for you, there are many alternatives that work great. Unfortunately, there is a lot of trial & error to finding the right meds. Take care.--Suzy P.S. Take a list of questions in when you see your doc. I always do or I forget something I was concerned about.

[DaveyJones]

I have had a bit of weight gain, nothing major, and moving back with my parents probably accounts for some. I haven't heard much about the others.

Toxicity symptoms include tremors and diarrhea and basically the stuff on the side effect list. I had tremors for a while, but they ceased when I stopped taking Wellbutrin. I've had some trouble with diarrhea, but nothing major.

I think a key to minimizing side effects is to maintain the water intake, that really seems to help. And no, you shouldn't take any of the NSAIDs, including aspirin and ibuprofen, they can mess up your levels. Here I think it is frequent use that is the real problem...I try to use Tylenol most of the time now, but if I really need ibuprofen, I'll take it. (I'm not supposed to take Tylenol with Lamictal, so what's a boy to do)?

As for drinking...I have kept my drinking to a minimum ever since I started taking psych meds, which was a drastic thing for me. I think the worst problem with lithium would be the dehydrating effect of alchohol--again, messing with your levels. Since you've been going at this for a while now, I'm sure they have told you that drinking isn't good for depression anyway...you may want to reconsider your drinking habits, not just because of medication, but because it will aid your recovery. Trust me, there aren't very many folks who like beer (and everything else) more than I did...but I managed. I still have a beer or glass of wine on occasion. The idea here is that you are looking for a long-term balance. You just moderate taking or drinking things that upset the balance for long periods.

Another thing you hear about is being "slow" or "foggy". For people who spend a lot of time in mania, lithium really does slow down the thought process. I never thought that I had racing thoughts until I went on lithium. It did feel a bit strange for a bit, but I got used to it quickly...and then I realized that several other symptoms that were a result of racing thoughts, like "brain freezes" were gone. Much better, but it took some getting used to.

Like Suzy says, there are lots of other things to try if lithium turns out not to be for you. It's just the best scientifically proven treatment for bipolar, so your doc is starting there first.

DJ

[Taipans]

Ok so atleast you didnt go bald and all your teeth fell out. That was my main concern, and I take advil alot for my carpal tunnel in my hands.... Tylenol doesnt do much, but if ibuprofen messes it all up then I will just have to switch over.

Ya I know about the drinking, depression thing. My depression foremost was not my major problem it was my social anxiety and mood swings. I was never super depressive, just kind of blah all the time. Anyhow I dont drink much. I'm refferring to a few beers on a sunday during a game, or if my wife and I go out for dinner and I have a couple glasses of wine or a martini or something. I sometimes go months without anything, but I just wanted to know if I had a few beers while grilling one weekend if with the Lithium I would have some very bad effect?

Damn it sucks about the Advil, I guess as long as I dont go bald and toothless I can give up on that. lol

As usual, thanks so much to everyone for your support and advice! My doctor hopefully goes into more details and warnings with me when I actually jump up trying to find the theraputic dosage.

This Lithium thing sounds like a balancing act though, kind of like if you were diabetic.

OH and another thing, how often once you find the right dosage do I have to get my blood tested?

Mark

[DaveyJones]

Yeah, the bald thing would be a killer for me! I did enough damage to my teeth with bubble gum a few years ago...that might have changed my mind.

A few beers on Sunday isn't a big deal...you need 'em if you're a Rams fan (doh! Sorry, couldn't help that)! It's OK, I'm a Titans fan...YIKES!

The Advil thing I would talk to the pdoc about...he might have some alternative pain meds for your hands.

As for testing, they'll do once a month for 2 or 3 months, 3 months after that, and maybe longer after that...it just depends on the doctor.

As for info from the doc...learn as much as you can and ask as many questions as you need to...he's gettin' $300-$400 and hour...make him earn it!

DJ

[darkeyes]

Not everybody suffers negative side effects, but pharmaceutical companies are legally required to list all or any side effects.
The tooth decay thing can go with many meds, and not just mood stabilizers, even antibiotics,oral contraceptives,hormone replacement,nutritional supplements,etc. while using those medications, it is a good idea to pump up oral hygeine (sp?). Especially flossing, which is important even if you are not on any meds.
The baldness, well that is questionable, again not everyone using a medication will experience all this scarey stuff.
I had a professor who has been on Lithium for life practically, and he had a great head of hair, he had to be in his mid 50's plus.
Weight gain? Heck at a certain age, regardless of meds. we gain weight, and again so many medications have this side effect for some people. I'm one of those that suffers the side effect "may cause weight gain", I'm never the one that gets the other side effect that many meds have on their list, "may cause weight loss". Grrrrrr! For me, when on Depakote, I gained 15lbs in one month and was constantly fatigue, falling asleep even while driving, got off of that med. real quick, after falling asleep waking up before nearly driving off PA tpk. lined with the boulders, I do not know what made me wake up, maybe the rumble strips?
If possible, try not to let all this stuff make you so scared to give something a try, as long as you are working closely with your pdoc with this, and always call him or her if there are unusal (sp?) things happening.
I use to research every med prescribed to me and/or family members, so often opting not to take them, turned out this is not a good thing either. Now when I am over tempted to read up on meds. I distract myself, doing something else.
All this stuff can drive someone bonkers, don't deny yourself of something that may have more positives than the negatives, if it doesn't work out there are so many alternatives. Takes time, but in the long run it is so much worth it.
I wish you lots of luck with this, keep us updated.
DE

[Taipans]

Ya you’re not kidding, but hey the rams somehow took Arizona last weekend so who knows!

Ya I shouldn’t get so paranoid over it, I mean every time I have read the package of possible side effects it scares the crap out of me. But even after around 15 different medications I have never had one side effect besides tiredness and change in appetite. lol

My primary physician doesn’t know much about any of this, is that who you meant by Pdoc, or are you talking about my Psychologist?

Of course as I told Davey in a private message im not super close with him. Only saw him twice and he isn’t, well, full American lets say. So it’s hard to understand him. Ya so im probably screwed. haha

Thanks guys!

Mark

[DaveyJones]

Pdoc means psychiatrist, who most of us believe are the only docs qualified to be prescribing meds for bipolar. Including me.

I have known one regular doc I think would have done OK, the fellow who dx'd my ex's bp. He's one of the best infection specialists on the planet, and one of the smartest people, too. But even he sent her to a psychiatrist.

So, I would ask your doc what kind of experience he has with bipolar...maybe it's a lot. He sounds like he knows what he's doing...but I would seriously consider finding a good psychiatrist. Maybe ask your T (that's therapist or psychologist in PC-speak).

Maybe the Rams just wanted to mask Kurt Warner, just cause...I'll bet they wind up doing well, AWESOME defense. The Titans, well...

C ya,
DJ

[darkeyes]

Okay, many in denial may not like this, but through experience, allow only a Psychiatrist make the DX, not a Psychologist though they can help, but never let a family doctor or GP, make the call, they are not qualified in the field of prescribing meds. for our disorder or many for that matter.
I went down that route, most likely delaying me (years) of getting the proper DX and meds to go with it.
Just my 2 cents.

[rajeev_garg]

Hi Guys..

I am also a Bipolar man. I was just crawling internet to find some more info on this killer disease when I found this forum. I read most of the posts here and agree with all of you that diagonosis of Bipolar is most difficult thing. I was also treated for eight years for Major Depressive Disorder. Luckily for me I was on very low dose of Fluoxetine 20mg and it did not damage a lot of me except lots of money on overspending on high days.

For last one year, I think I am in right hands of a known Psychiatrist. I have been put on Epilex Chrono 500 alongwith Lametec 50mg twice a day as mood stabilizer. Then, I have been given Clonazepam 0.5mg whenever I move towards a high to bring me down and Prothiaden 25mg/75mg to bring me up when I am low.

Life is like a roller coster for me. Before going to right hands, I had alsmost died in two unsuccessful sucide attempts. But, after these mood stabilizers I am much better.

Regards,

Rajeev

Welcome. Rajeev. It sounds like you have a lot in common with many of us who were incorrectly diagnosed with unipolar depressions for many years before the correct diagnosis of bp was discovered. I thought I was bp II until recently when I changed ins. companies & they required a dx on the presciption form. I take Abilify & that is approved for bp I & I don't think bp II so I thought I was using it "off label" & was freaking out that the ins. co. would deny me my medication. My provider said, no, you're bp I ! I was so happy! She said she has never had that response. I learned that even though my manic phases were closer to hypo manic & not "out there" (still overspending, not sleeping, joining every orgainization in the world, contacting people I haven't spoken to in years , etc.) but I didn't get into any trouble with the law, etc., but in my depression I did have delusions & paranoia & had a mixed episode so that I "qualified" as bp I ! Happy day so I could continue on my current meds.--Suzy

[Taipans]

Yes welcome Rajeev and im glad your feeling much better!

[rajeev_garg]

Thanx for welcoming on Board.

Here in India, Insurance companies do not cover depressions like Bipolar Disorder. You tell them the truth and they will not sell you any insurance. My personal experience regarding BP is that every season change is most dangerous period for me. In October, winters starts setting in and every year this is one of the most difficult periods for me. This year, I appear to be on High. Having lots of work pressure, deadlines, I am feeling high that I can achieve it but deep inside I am afraid.

I am afraid if I fail it can be disaster to my business. It has happened to me last year too.

Any suggestions for coping with such situations.

Rajeev

[DaveyJones]

Hi, Rajeev...

There are a few things you can do at season changes to help, but they are really the same things you need to do whenever you're having trouble with your mood...

First, talk to your doctor...he should be able to adjust your meds to help smooth out the journey. Second, maintain a regular sleep schedule, 7 - 8 hours per night, at night. Third, excercise 20 - 30 minutes each day. A simple walk will do, if you can get outside even better. Natural light is the best thing. Fourth, maintain a healthy diet.

All these things are obvious, but it's so easy to blow them off when we are not feeling right.

One more suggestion--you can replace your regular light bulbs with "full spectrum" or "natural light" light bulbs. One of my pdocs said the problem this time of year is the rapid change in the length of the day...that's why it is so important to maintain a regular schedule. The full spectrum bulbs mimc the sun's rays, and help alleviate the effects of the changing seasons.

I hope there is something here to help you...I go through it, too. I've felt really bad this year...last year I was in the hospital!

DJ

[Taipans]

Rajeev I'm new to the Bipolar scene, going through many years of different disorders and medications. So I cant help much on Bipolar itself. (I'm sure Daveryjones can though) =P but I would reccomend doing what he said, and I know how you feel, once winter hits everything goes down the toilet for me too, the weight of life in general seems to press down on you. I do stay active in the winter months having a wife and kids though, which does help most of the time. If you dont have that to keep you busy, become a hardcore gamer, lol I would consider myself one of those as well, and nothing takes away all the depressive thoughts like 5 hours of Battlefield or a good mmorpg. =P

In any case its horrible your insurance doesnt cover mental illness, and that you cannot get any kind of treatment or medication? I wish I could comment something positive about that but it just sucks in general.

Keep your head up though, there are many good people around here that will give you support!

Mark

[rajeev_garg]

Dear Dj,

Thanks for your advice. My Doc has given exactly the same instructions. Sign wave of my mood is in maniac phase at the moment. I was awake whole last night. Rapid thinking went on. Finally, I sat on computer to get out of bed at 4:00 A.M.

During my last visit to my Doc, she asked me if there is any underlying unfullfilled desires. I replied "YES". I always wanted to be in Software Line as I was a good programmer way back in early 90s but landed in family business by default which is not doing great. It is always in back of my mind that I could have done much better professionally if I was in IT sector. She suggested me to bring those feelings out instead of suppressing further by taking pills. Now, I am trying to find a Free Lancer Job in softwares as I can't run away with my current business.

Rajeev